Abstract
When pancreaticoduodenectomy (PD) is performed in a patient with stenosis of the celiac artery, the intrapancreatic arcade is resected at the same time, which may increase the risk of ischemia of the upper abdominal organs, and lead to serious complications. To maintain sufficient upper abdominal blood flow in these cases, there are three methods, preoperative intravascular stenting, intraoperative median arcuate ligament resection, and intraoperative revascularization. Ordinarily, stenting alone, or one or two of these intraoperative methods described above are selected. We experienced an 89-year-old man with lower bile duct carcinoma (cT2, cN0, cM0, cStage II). Preoperative imaging showed a calcification at the root of the celiac artery, but almost no development of intravascular pancreatic arcades. In the first surgery, intraoperative gastroduodenal artery (GDA) clamping-test caused a marked decrease in hepatic artery pulsation and gastric blood flow, and we determined it was prudent to not perform radical resection. For an elderly patient like our case with angina/diabetes as a comorbidity, it is more important to ensure sufficient upper abdominal blood flow. We performed the second surgery (PD) successfully, using two of the methods together, preoperative vascular stenting and intraoperative revascularization (right gastroepiploic artery–3rd jejunal artery).
